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Flashcards in Smoking Deck (8)
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1

Does smoking really deserve its own chapter in this book?

Smoking is the single most significant source of preventable morbidity and premature death in the United States.

*this is a recurrent theme on the USMLE, so whenever you are not sure which risk fac- tor to choose to reduce morbidity or mortality, smoking is a safe guess*

2

How is smoking related to heart disease?

Smoking is responsible for 30% to 45% of such cardiac-related deaths in the US.

This risk is decreased by 50% within 1 year of quitting, and by 15 years after quitting, the risk is the same as for someone who has never smoked.

3

What cancers are more likely in smokers?

Almost every part of the body:

  • lung (smoking causes 85%-90% of cases)
  • oral cavity (90% of cases)
  • larynx
  • pharynx
  • esophagus (70%-80% of cases)
  • stomach
  • colon
  • rectum
  • bladder (30%-50% of cases)
  • kidney (20%-30%)
  • pancreas (20%-25%)
  • cervix

4

Describe the effect of smoking on the lung.

  • Lung cancer
  • chronic obstructive pulmonary disease (COPD; emphysema, chronic bronchitis, and bronchiectasis)
    • Emphysema almost always results from smoking; if the patient is very young or has no smoking history, you should consider alpha1-antitrypsin deficiency. Although the changes of emphysema are irreversible, the risk of death still decreases if the patient stops smoking.

5

What about second-hand smoke?

Second-hand smoke is a proven risk factor for lung cancer and other lung disease; risk increases linearly with increasing exposure.

When parents smoke, their exposed children are at an increased risk for asthma and URIs, including otitis media.

6

What other bad things does smoking do?

Smoking

  • retards the healing of PUD
  • increase risk of Buerger disease (thromboangiitis obliterans - vasculitis of small/medium sized arteries and veins, results in ischemic claudication of extremities and may subsequently lead to paresthesias/ulceration/gangrene)
  • increases the risk of low birth weight, prematurity, spontaneous abortion, stillbirth, and infant mortality
  • Cessation of smoking pre-op is the best way to decrease the risk of post-op pulmonary complications, especially if it is stopped at least 8 weeks before surgery.

7

True or false: Women who smoke cannot take birth control pills.

True!! 

if the woman is > 35 yo + smokes OR  < 35 years + smokes > 15/day, the risk of thromboembolism is increased sharply if they take OCPs.

Postmenopausal women, however, can take estrogen therapy regardless of smoking status.

8

So what is the bottom line for the boards?

Smoking is a very dangerous habit that should be avoided.